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Open Access Research article

Increased cancer mortality in diabetic people treated with insulin: a register-based follow-up study

Erja Forssas1*, Reijo Sund1, Kristiina Manderbacka1, Martti Arffman1, Pirjo Ilanne-Parikka2 and Ilmo Keskimäki1

Author Affiliations

1 National Institute for Health and Welfare, (THL), Service System Department, P.O. Box 30, FI-00271 Helsinki, Finland

2 The Finnish Diabetes Association, Tampere, Finland

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BMC Health Services Research 2013, 13:267  doi:10.1186/1472-6963-13-267

Published: 9 July 2013



The national 10-year Development Programme for the Prevention and Care of Diabetes (DEHKO) was launched in Finland in 2000. The program focused on improving early diagnosis of type 2 diabetes and preventing diabetes-related complications. The FinDM database was established for epidemiological monitoring of diabetes and its complications. This study monitors mortality trends among people with diabetes during the DEHKO programme.


A database obtained from a compilation of several administrative national health registers was used to study mortality in people with diabetes in 1998–2007. Relative excess mortality between people with and without diabetes was analyzed using Poisson regression models.


The number of diabetic people in Finland increased by 66% from 1997 reaching 284 832 in 2007. Like among non-diabetic people, all-cause mortality decreased in people with diabetes. Overall excess mortality remained high in people with diabetes; in 2003–2007 RRs in the non-insulin treated was 1.82 for men and 1.95 for women and in the insulin treated 3.45 and 4.29, and excess coronary heart disease mortality in the insulin treated: RR was 4.71 in men and 7.80 in women. A striking result was mortality from neoplasms; an increase in mortality emerged in almost every age group of insulin treated women.


Compared to non-diabetic people our monitoring showed declining excess mortality in non-insulin treated diabetic people mainly due to a decrease in mortality from cardiovascular diseases. For insulin treated, relative overall excess mortality remained unchanged and mortality from neoplasms increased among women.

Diabetes mellitus; Excess mortality; Monitoring; Register study